Expert: Claes-Gustaf Nordquist, M.D. - 11/2/2009

Question
Four weeks ago I had a colonoscopy.  Several flat polyps were burned off.  One polyp/tumor in the anal region resistant to removal during the colonoscopy.  The following day the Dr. removed the polyp/tumor as well as a hemmroid and sent them for biopsy.  Ten days later the Dr informed me that the polyp/tumore was benign but the hemmroid was precancerous in-situ.  He also said to return in a month for follow-up.  (Total of 6 wks since removal of tissue.)

I had requested a copy of the report - it did not say pre-cancer - it said squamous carcinoma in-situ without clear margins. I referred to my gp and she said it was cancer but, she defers her opinion to the specialist.

My question - What should I do?  Nothing is being done and I am still having bleeding and considerable discomfort.  The stool is still very narrow, sometimes coffee grind like and pencil like with bright red blood at other times.  

Bless you for taking the time to consider my question.  I am concerned and don't want to wait and cause further issues.  

Answer
A cancer in situ or cancer stage 0 is a "cancer in site". That means that it is localized in a small area (often even microscopic) ONLY and shows no tendency of invading even directly neighboring tissues. For the diagnosis to be SURE however the WHOLE lesion must have been surgically removed by the surgeon and studied by the pathologist. That seems not to be the case here since the margins of it were not clear! So extended surgery of the site of your lesion IS INDEED NECESSARY to 1. make sure that the WHOLE lesion has been removed with a safe margin and 2. to evaluate the diagnosis with certainty! You have to INSIST on this! Please do keep me posted!